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I don't﻿﻿﻿ actually believe that some people "have" OCD and others don't; I think OCD develops over time as a result of carrying out compulsions. It teaches ﻿th﻿e brain to respond like this habitually. I think anyone can develop OCD if they learn to use compulsions as a coping mechanism﻿

It's easy to develop a phobia - and I reckon if obsessive thinking is about in the background and kicks in, then we can start up a theme of OCD - add the compulsions, generate the disorder and, sadly, there you go.

There may not be a phobia - but there can still be some seeding event, even perhaps the obsessiveness of a relative.

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Jeffrey Schwartz sees it that way as well. Whatever you practise will become more entrenched. Usage of neural pathways in responding to intrusions in a maladaptive manner will cause habit. It makes sense that people could become more OCD like by behaving and responding to thoughts maladaptively

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Whatever the source, you noticed that thought and responded with anxiety. Because of the anxiety reaction we then give it importance and enter the cycle of obsessing, using compulsions, avoidance etc.

I should point out I'm second-guessing and giving an example of the type of situation/series of events that could happen rather than describing your actual situation. Hope that makes sense.

The bottom line is that we are not automatons and there will be many variations

Right, but the reason I responded with anxiety rather than dismissing the thought out of hand is because of the underlying condition, OCD, which causes a malfunction in the brain. Were it not for the underlying flaw/malfunction/bug of OCD I wouldn't get stuck in the anxiety loop, it would just pass through as normal. If the OCD was instead, the RESULT of the anxious response, I should be able to short circuit it with simple reasoning, I should be able to have the thought, start to feel anxious, recognize the anxiety and tell myself "oh don't worry, the odds of that being true are 1 in a trillion, you can relax", just like we all do most of the time anyway and people without OCD do all the time.

Further supporting the idea that there is an underlying biological cause that leads to the symptoms (such as compulsions) are twin studies which show that identical twins are much more likely to both develop OCD than non-identical twins. If the source of OCD was environmental or situational then there would be no difference between these types of twins since they are raised in the same environments and exposed to the same general factors. All the evidence we have strongly points to OCD having a biological origin, though absolutely the environmental and life factors can increase or decrease ones likelihood of onset of symptoms.

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I have long felt that my, biological, sister and I both have OCD through some genetic link.

I think this to be so, but we aren't twins.

So for me there can be :

genetics

phobia

seeding events plus learned responses

propensity to worry and overthink leading to OCD

A locking brain producing repetitive thoughts

All causation of OCD.

To be clear I don't disagree that our behavior can not worsen/improve our OCD symptoms. Absolutely this is true. And environmental factors can play a part in how/when we experience OCD. But the condition itself, the vulnerability is present due to a brain malfunction/flaw.

I do not believe that "anyone can develop OCD" for example anymore than anyone can develop alcoholism. Some people have the vulnerability, some don't. Some people can drink copious amounts of alcohol without ever becoming dependent on it and some people can't have one drink. Likewise some people can experience extreme situations of anxiety and stress on a regular basis and never develop OCD, and other people can experience a stray thought out of nowhere in the most peaceful of situations and it can trigger an OCD response.

The reason I am so passionate about this topic is because we used to (and some people still do) treat conditions like alcoholism or OCD as a sign of mental weakness, the inability to behave properly and that the solution is merely to have enough willpower. I believe this is problematic because it places the burden entirely on the sufferer. But we have ample evidence now to demonstrate that these conditions have an underlying biological cause. While its still important for the sufferer to take action if they wish to recover, its important to realize that merely having OCD is not our fault. Its not something that happened to us because of something we did (or didn't) do, but because of something outside our control. Yes, we must take an active role in our recovery, and yes, thanks to the reality of neuroplasticity we can adapt our minds to work around the defect, but a person who loses their right hand and has to learn to write with their left still lost their right hand. And a person who learns to adjust their thinking to deal with the maladapted thinking that OCD causes still has the underlying flaw, they've just learned to work around it.

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Your post is really interesting. I think you know more than me about the current research, but I was under the impression that the jury was still out on whether the differences in the brain are a cause or a consequence of having OCD.

I don't necessarily think it naturally follows that if OCD didn't have a biological origin, it would mean OCD is a person's fault - any more than I think, say, homelessness is a person's fault. I think the human brain is complicated, and life is complicated, and things can combine to create vicious spirals of various kinds. There's also the fact that even if a lack of biological origin would place the burden on the sufferer, this in itself is not a case for this biological origin being necessarily true.

You say that dismissing biological origins puts the burden on the sufferer - but surely it also empowers the sufferer to be able to take steps to cure it?

Anyway it is an interesting discussion and my thoughts around this evolve over time. It's good to hear others' opinions

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Dozing in bed prior to a shower, and online on my smartphone, I am going to toss mindfulness into the ring.

Mindfulness was the gamechanger for me. It enabled me to stop the constantly-repeating OCD intrusions in my mental chatter and shut off the "scanner" that was seeking out, then focusing in on intrusions.

How does it do this? According to my clinical psychologist ( who does have a PHD in it) we do all our obsessing and compulsing in a part of the brain that seeks answers and won't let up until it gets them.

But in the benign, just being, part of the brain is where mindfulness can be found - and all that active, doing, stuff is left behind.

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The﻿ reason I am so passionate about this topic is because ﻿we used to (and some people still do) treat conditions like alcoholism or OCD as a sign of mental weakness, the inability to behave properly and that the solution is merely to have enough willpower. I believe this is problematic because it places the burden entirely on the sufferer. But we have ample evidence now to﻿ demonstrate that these conditions have an underlying﻿ biological cause. While its still important for ﻿the sufferer to take action if they wish to recover﻿﻿, its important to realize that merely having OCD is not our fault. Its not something that happened to us because of something we did (or didn't) do, but because of something outside our control.

I am totally on board with your passion. I agree that people very much placed the burden on the individual to pull themselves together and agree that the cause of OCD is outside our control. However, there is not enough evidence to suggest it's a malfunctioning brain, there's no evidence to suggest that. Brains of people with OCD are physiologically the same as those without and brain images with increased blood flow in certain regions have never shown cause over causation. Also, any biological explanation of mental health problems has always been shown to be more stigmatising than environmental explanations. So it's actually counter intuitive to press the biological issue to get people to have more understanding and sympathy.

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What’s the difference between willpower and commitment to therapy? When I resist a compulsion I think that it takes a degree of courage because part of me thinks that the compulsion is making me and others safe.

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AAs GBG says, this is a very interesting discussion and seeing the different points of view.

Quote

﻿﻿But﻿ th﻿e conditio﻿n itself, the vulnerability﻿ is present due﻿ to a brain m﻿alfuncti﻿on/fla﻿﻿w﻿.

As the decades fly by, experience and observation has made me shift opinion on this. However, it is just opinion.

10 hours ago, dksea said:

Right﻿﻿, but the reason I responded with anxiety rather than dismissing the thought out of hand is because of the underlying condition, OCD, which causes a malfunction in the brain. Were it not for the underlying flaw/malfunction/bug of OCD I wouldn't get stuck in the anxiety loop, it would just pass through as normal. If the OCD was inste﻿ad, the RESULT of the anxious response, I should be able to short circuit it with simple reasoning, I should be able to have the thought, start to feel anxious, recognize the anxiety a﻿nd tell mys﻿elf "oh do﻿n't worry, the odds of that being true are 1 in a trillion, you can relax", just like we all do most of the time anyway and people without OCD do all the time.

"Should be able to short circuit it with simple reasoning" Should, but would you, could you? You could apply that same reasoning to someone who suffers panic attacks. Tell them it's a simple fight or flight reaction and they should be able to control them. Yes, they should and can theoretically but the power of the anxiety, the level of fear can see them rendering people housebound or very restricted for years. Simple phobia's similarly. Someone can develop a phobia of something as simple as buttons which will see them restrict their life so severely it affects them at every level. Explanation and reasoning should be enough to aĺlow them to simply dismiss it......but they don't.Such is the power of anxiety sometimes.

13 hours ago, dksea said:

do﻿ n﻿ot believe th﻿at "anyon﻿e﻿ can develop OCD" for exam﻿ple anymore than anyone can develop alcoholism. Some people have the vulnerability, some don't. Some people can﻿﻿﻿﻿drink copious amo﻿unts﻿ of alcohol ﻿without eve﻿r﻿ becomi﻿ng de﻿pendent﻿ on it a﻿nd som﻿e peo﻿ple can't ha﻿ve one﻿ dr﻿ink﻿

There are professionals within the field of Psychiatry that no longer believe alcoholism is a disease but an addiction

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Apologies for the delayed reply, I'm not on here much. Thanks for your responses, it's good to hear others' thoughts and input.

Few things I wanted to clarify - I don't believe psychodynamics therapy or talk therapy would be helpful, as I agree it's pretty ineffective for many conditions especially OCD. It's just mulling around in circles most of the time. I think what I mean is addressing these underlying beliefs in more up-to-date ways. There are many modern therapies and practices that can help people challenge their subconscious patterns and process them, including Organic Intelligence, somatic experiencing, jungian play therapy etc etc. As dskea said, I believe CBT should be along side other therapies to get things under control, but ultimately yes, this stuff has to be looked at if we're aiming for deeper transformation and recovery.

Also, I've not done past life regression for years. It was very helpful at the time, along with a few others things which contributed to me being able to wean off medication. I managed to resolve a few underlying issues almost immediately through it, same goes for drinking Ayahuasca in a ceremony, but that's a whole other story lol.

In terms of the spiritual side of things, I was always an atheist/agnostic. But now, I don't believe I would ever have got past that severe point of my OCD stuff without developing a spiritual practice. This was triggered by taking psychedelics in my early 20's (not recommending but explaining how it came to be) - I saw immediately that there was a whole reality outside of 'me' and my OCD. It made the mental issues seem ridiculously insignificant, and I still get glimpses of it at times. That alone was enough to start healing in huge ways and gave me an underlying knowing that everything is actually all okay deep down. Once you've had those experiences you never truly lose them, even if you get clouded over at times.

After that last 'wave' of withdrawal, things are improving every day. I feel better now the past 2 months than I have, well, ever. I don't ever remember having this level of creativity, motivation, gratitude, hope. The difficult beliefs etc that are arising are doing so in a much more present way, in that I view them very differently than I would have a few years back. Bad days are just that, bad days. All former symptoms of withdrawal have disappeared (as they do during a 'window' phase), except for a little tinnitus at times. And the OCD is pretty non existent. Not that it won't flair up, my brain is still healing and I know there will be more waves, but it's quite astonishing the level of improvement. I feel like I'm coming alive, challenging my whole former identity, and it's exciting. Tough at times, but exciting. After each crazy wave it's as if things get gradually better and better. I'm looking forward to getting off the last 5mg.

But I know this is a lifelong journey of self discovery once you start delving into these things. I appreciate being able to explore this stuff a bit with others here, so thanks again for sharing your thoughts :)

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Thank you for this thread, I haven't read all of it but it is something I have been thinking about lately too. I would really love to know why I have OCD. It seems that some people can point out a period when their OCD began, but for me, it goes as far back as I can remember in my childhood. I have never lived without OCD and I would like to understand why I have it, but I don't think there is a clear reason or underlying cause. I think that various life stresses have made it worse, but it has always been here.

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Your post is really interesting. I think you know more than me about the current research, but I was under the impression that the jury was still out on whether the differences in the brain are a cause or a consequence of having OCD.

While its true that the exact cause/effect of the measured differences in brain scans isn't known, the fact that there are differences, plus the effect of medication on OCD, plus the results of twin studies, plus the fact that OCD onset can occur absent any significant external stress, all lead to the generally accepted conclusion that the underlying issue is biological in nature. Absolutely, as you mention human minds and lives are complicated, and I don't think anyone in the field would deny the effect that our environment can play on OCD. Many conditions are biological in origin but not guaranteed to occur even if one posses the vulnerability. Some conditions and traits are guaranteed if you have the underlying biological cause, say hemophilia or blue eyes, while others merely increase your chances of having the disease (or you don't have the possibility unless you posses the underlying flaw).

17 hours ago, gingerbreadgirl said:

You say that dismissing biological origins puts the burden on the sufferer - but surely it also empowers the sufferer to be able to take steps to cure it?﻿

One of the amazing things about the human mind, and fortunate for sufferers of mental illness such as OCD, is the flexibility and adaptability it displays. So even if (as seems to be the case) OCD has an underlying biological origin, we can take advantage of neuroplasticity of the brain to adapt and work around it. For example, consider the situation of a person who suffers a stroke that affects the language center of their brain. Suddenly they can't speak anymore. That part of the brain is damaged, and unfortunately we lack the ability to change that. BUT what is amazing is that people can, through therapy, relearn how to talk and other parts of the brain will pick up the slack. But the underlying damage is still there, even as our brain learns to work around it.

So yes, absolutely I believe a person can (and should!) take active steps to manage and recover from OCD and that OCD having a biological origin doesn't change that. We know CBT can work, we know medication can work (and together they can work even better than either alone). Having a biological disease doesn't mean a person should only wait on a biological cure, we must also learn to manage the condition ourselves because it leads to better lives. For example I have had asthma since birth. Its a biological reality that I have lived with my whole life. Unfortunately it can't be cured, but fortunately it can not only be treated with medication, but I can take active steps in my life to reduce its severity/virtually eliminate it from my day to day life. I can avoid certain triggers, I can keep my living area clean of unnecessary dust, etc. AND I can keep my body in good cardio-vascular shape (i need to do a better job of that, heh) which strengthens my lungs overall and reduces the impact and risk of my asthma. It doesn't eliminate the risk completely but it improves my overall life. Similarly one can take active steps to reduce the impact of OCD on ones life, possibly to the point where they are virtually "cured", at least for long stretches of time.

However, I do not personally believe (along with many experts in the field) that OCD can be "cured" at present. I think what a lot of people describe as being "cured" is merely a kind of remission. The OCD is under control to the point where you don't think about it for long stretches of time, perhaps years, but the vulnerability is still there and relapses are always possible. While the difference between cure and remission may seem unimportant, for example if a person has gone say 10 years without any noticeable OCD problems, why not call yourself cured, I think it DOES matter. I think if you consider these forums for example you'll find many examples of people whose posts are along the lines of "for XXX time I wasn't having any problems with my OCD, but then it came back". I personally have gone through this cycle more than once, and the times where it hit me the hardest were the times I had become completely complacent in my management of OCD. I had stopped keeping my eye out for symptoms of recurrence so when it hit, it was a shock. Overtime I learned that even when I am living virtually OCD free its important to be aware of potential relapse and notice the symptoms. By doing so I have managed to turn what could have been major OCD relapses into minor ones that were far less stressful and I was able to recover far quicker. Of course its up to each individual to decide what status they consider themselves to be, and if a person truly believes they are cured and are happy living their life that way, I absolutely respect their right to do so. But in my experience thats a much more risky proposition, and its better in the long run to accept that OCD can be managed (quite successfully) but not cured. I have OCD, for the foreseeable future I will always have OCD. That doesn't mean I will always experience the symptoms of OCD, but the possibility is always there, much like an alcoholic will ALWAYS be an alcoholic, but that doesn't mean they will go and get drunk. They can manage their vulnerability just like I can manage mine, and lead a relatively "normal", fulfilling life in the meantime.

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"Should be able to short circuit it with simple reasoning" Should, but would you, could you?﻿

Absolutely I would and I have tried DESPERATELY to do this time after time. I have sat there, confident in my knowledge of the realities of the situation, knowing all the details, knowing the data, the science, the facts, and STILL felt anxiety for no discernible reason. I KNEW in my head that my fear was ridiculous, yet I also couldn't stop feeling anxious about it. OCD defies logic, it laughs at logic, its why we can ruminate for hours on a worry and go down increasingly unlikely to virtually impossible paths in our minds and yet "feel" like its still possible. Its why reassurance doesn't work, because there is something fundamentally wrong in how our brain is working. Yes we can use behavioral therapy to adjust to this malfunction and work around it, but that doesn't mean the defect doesn't remain there.

13 hours ago, Caramoole said:

There are professionals within the field of Psychiatry that no longer believe alcoholism is a disease but an addiction

Alcohol addiction (along with other addiction) also demonstrates a biological component that puts some people at greater risk than others. Alcoholism is known to run in families, even if the parents never exhibit or demonstrate alcoholic behavior in front of their children. Anecdotally I have a college friend whose father was an alcoholic and gave it up before having children. His son also later had to give up drinking because he too was an alcoholic.

Again, to be clear, having a genetic basis does not mean I think that behavior and environment play no role, absolutely they do. Nor does it mean that we can't use behavioral modification to adjust to having OCD and adapt to manage it better, we definitely can, just as I mention in the example above, a person whose brain is damaged by stroke can learn to talk again using other parts of their brain. Nor does it mean that the behaviors we engage in because of the OCD can't become worse because of the cycle of anxiety, absolutely they can. Having a biological basis does not mean I think a person is destined to develop a hand washing compulsion. The exact circumstances and presentation of OCD will definitely be effected by the environmental and individual circumstances. But underlying it all, the heart of the whole problem is something (or somethings) in our brain that isn't working the way it should. I've seen a lot of evidence to support this and no evidence that would contradict it. Does that mean it doesn't exist? No, i haven't read every piece of literature on the topic. But absent strong supporting evidence to believe otherwise, it makes the most sense to go with the solution that fits best.

As to phobias, its entirely possible that there exists a biological vulnerability there as well. There is in fact evidence to back up that belief based on current research even. Again that doesn't mean a person can't overcome a phobia with the right treatment, but the whole reason they developed a phobia in the first place (while another person in the same situation doesn't) could absolutely have a biological component. Just like people having different food likes and dislikes can be related to genetic differences in addition to experience and environment.

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While its true that the exact cause/effect of the measured differences in brain scans isn't known, the fact that there are differences, plus the effect of medication on OCD, plus the results of twin studies, plus the fact that OCD onset can occur absent any significant external stress, all lead to the generally accepted conclusion that the underlying issue is biological in nature.

Hi Dksea,

Again really interesting to hear your point of view

I'm not sure the differences in and of themselves really point to a biological origin. The differences are not unexpected - any behaviour carried out repeatedly can change the brain (as you've alluded to). There's a famous study showing that London cabbies have a substantially larger hippocampus than the average person - this doesn't mean being a cabbie is genetically determined (although maybe people who go on to be cabbies have a greater ability to develop this part of their brain) but more likely it means the act of repeatedly navigating, remembering etc. has an effect on the brain. Similarly I believe repeatedly carrying out compulsions changes the brain and lays down pathways which physically alter the brain which can make it appear different to those of non-ocd sufferers. This doesn't necessarily mean there is a biological origin.

I also don't believe the effects of medication necessarily mean there is a biological cause. As far as I'm aware, medication allows for a more balanced mood (in some) which allows them to carry out behavioural therapy more effectively. Having a more balanced mood would also allow a person to, say, relate better to their family - but this doesn't mean there is a biological basis to poor communication. My belief is more that OCD leads to immense suffering and medication can alleviate that suffering to a degree, enough for the person to engage with therapy. That doesn't necessarily point to a biological basis, in my opinion.

I don't know about the twin studies and would be really interested to read about them.

The fact that OCD can occur minus any significant stress - again I don't think this necessarily points to a biological origin. Regardless of what was happening prior to the intrusive thought, there is always stress involved. If I am calm, watching TV, relaxed; and I get an intrusive thought about being a murderer - this is not OCD, this is normal human experience. Everyone gets intrusive thoughts about all kinds of garbage. Where OCD comes in is in my reaction to the thought. And my reaction very much depends on whether the thought makes me anxious or not, which in turn depends on how I interpret it. If I interpret the thought as having meaning for me, pointing to my true character etc, then I will have an anxiety response and it is then that the compulsions kick in. I don't believe there is anything automatic or biological about this - it is a learned response. Even if I am relaxed beforehand, there is always stress and anxiety involved when carrying out compulsions, or I simply wouldn't do them. It is the compulsions which cause the thought to be "stuck", not a mangled brain, in my opinion.

You say that it is a generally accepted conclusion that OCD has a biological basis but (and apologies if this is blunt at all) I'm not sure if this is the case, I was under the impression this was debated quite heatedly in the psychological community?

I used to think very similar to you. I had a very sudden onset of OCD-like behaviours as a child (and also some element of tourettes I think) and I long felt that this sudden and seemingly automatic change pointed to something biological in my brain. In many ways I clung onto this explanation. But actually I think there was probably something going on in my life at the time which created anxiety and I adopted compulsive behaviours to deal with it. Perhaps a predisposition to anxiety has genetic elements, I don't know.

I have a question if that's OK (and I really don't want you to think I'm attacking, I am really interested and I certainly do not know it all) - but if OCD is biological, why have I gone long periods without any symptoms whatsoever (or virtually none)? My relapse this year had a very definite cause (the Harvey Weinstein revelations in Oct last year) and was linked entirely to my behaviour, how I responded, compulsions I carried out, which quickly escalated into a big mess. If I'd responded differently to those news stories I wouldn't have had my relapse. How does the biological element fit into all this?

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If I am calm, watching TV, relaxed; and I get an intrusive thought about being a murderer - this is not OCD, this is normal human experience. Everyone gets intrusive thoughts about all kinds of garbage. Where OCD comes in is in my reaction to the thought. And my reaction very much depends on whether the thought makes me anxious or not, which in turn depends on how I interpret it. If I interpret the thought as having meaning for me, pointing to my true character etc, then I will have an anxiety response and it is then that the compulsions kick in. I don't believe there is anything automatic or biological about this - it is a learned response.

Sure, it is the anxiety that is the biggest problem with OCD, if we didn't feel the anxiety, no problem right? But WHY do we get stuck in an anxiety spiral? Why does a thought that is otherwise meaningless start to bother us for no reason all of a sudden? And why can't we reason our way out of it? Meanwhile why do other thoughts, other anxious thoughts not result in similar anxiety spirals? If this is a learned behavior shouldn't we respond similarly to similar thoughts? For example you point to the random thought of being a murderer. Why, all of a sudden, out of the middle of nowhere does that thought popping in to your head lead to an anxiety spiral? Why can't you just tell yourself, "Thats silly, of COURSE I'm not a murderer!" and get on with your day? If OCD is based on our interpreting thoughts a certain way, we should be easily able to counter it by choosing to interpret them differently. I should be able to short circuit OCD from the get go by simply deciding that the meaning of a particular thought is meaningless. If all it took was reason and logic, OCD would be easy to beat, you'd just look at the worry say "thats silly" and be done with it. Or say "What are the odds that touching this lamp ten times will keep my family safe? Zero."

A learned behavior requires reinforcement and training. We engage in learned behaviors because there is a REASON to engage in them, either to avoid an outcome (negative reinforcement) or to pursue an outcome (positive reinforcement). Pavlovs dog's learned to salivate at the sound of the bell because of a reward. Mice in a lab learn NOT to eat the cheese on the blue square because they get a shock every time they try and touch it. In order for the anxiety spiral of OCD to be a learned behavior we would need some kind of training to encourage that behavior in the first place. But the exact OPPOSITE is the case with OCD. When we have an unwanted thought we get NEGATIVE feedback. If anything that should make us want to have nothing to do with that thought, instead we dive in, we dwell on the thought, we think it over and over and over again, we fixate on it, despite the fact that doing so causes us immense pain. Where is the reward? Where is the positive reinforcement that helps build the addiction? "But what about other destructive behaviors like drugs or alcohol!" you respond! Its true these habits can lead to negative behaviors but they generally don't at first. When you start drinking you enjoy the experience, you feel GOOD. There may be negative consequences after (hangover), but you engage in the behavior despite those consequences because the good outweighs the bad. Eventually thats no longer true, but by then you've developed a dependence and the habit is deeply ingrained. In addition there is often a withdrawal cost that you estimate is worse than the other downsides. In fact, one treatment for alcoholics is a drug called Disulfiram (or Antabuse) which invokes an immediate hangover type response to the consumption of alcohol. Basically you skip over the fun parts and suddenly alcohol is ONLY a negative experience, with the idea being that you'll come to associate only the negative aspect with alcohol consumption and therefore break your habit. So back to OCD, how can the initial anxiety spiral be a result of learned behavior? Where is the positive reinforcement? I doubt you'd find many OCD sufferers who enjoy the experience of anxiety spirals after all.

Now, where behavior DOES come in is the compulsions. We engage in, and in many ways, become addicted to compulsions in response to intrusive thoughts precisely because they generate a positive feedback. When we do the compulsions we gain that sense of "completeness" that we are lacking from the intrusive thought. So we engage in them over and over again because they DO make us feel better, at least temporarily. I mean, why wouldn't we? We want to end our pain and anxiety and compulsions seem to be the only way how. Of course we know that long term they are just making things worse, much like an alcoholic or drug user who continues to use feels short term relief at long term cost. It takes an effort of will to break out of that learned behavior cycle and look at the long term goal, just like it takes an effort of will to seek help when recovering from addiction or to break other bad habits we have fallen in to. So yes, there is a behavioral learning component to OCD, and i"m sorry if I wasn't clear on that before, but the underlying source of the anxiety, the part that doesn't make sense as a learned behavior, the ultimate source of our OCD is the malfunction of our brain that leaves in the state were we can't silence the doubt about our intrusive thought, that leads us to seek relief in the form of compulsions in the first place. Because if you take away the power of the intrusive thoughts of the OCD suffer (which is one way in which medication can help) it becomes easier, in some cases dramatically so, to stop the compulsions. Absent the drive to seek comfort from the anxiety, the compulsion is no longer rewarding. If you don't feel anxiety at the thought of being "contaminated" why wash your hands 10 times? It becomes pretty boring pretty quickly. Once becomes enough.

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I have a question if that's OK (and I really don't want you to think I'm attacking, I am really interested and I certainly do not know it all) - but if OCD is biological, why have I gone long periods without any symptoms whatsoever (or virtually none)? My relapse this year had a very definite cause (the Harvey Weinstein revelations in Oct last year) and was linked entire﻿ly to my behaviour, how I responded, compulsions I carried out, which quickly escalated into a big mess. If I'd responded differently to those news stories I wouldn't have had my relapse. How does the biological element fit into all this?

Basically, whatever the malfunction is that causes us to experience OCD hampers our normal response, but doesn't completely break it. Think of it like an older, kinda run down car. Some days its starts normally, some days you have to try a few times for the car to start. Something, somewhere (probably in the starter) isn't working like its supposed to. Its not completely broken, but its damaged. And sometimes external factors increase or decrease the problems with that part. Maybe in the winter, when things are cold, the metal shrinks a bit and the part has just a bit harder of a time connecting, so your car has even MORE trouble starting in the winter. But if you were to replace that broken part, the weather would no longer matter, cold, hot it would function like its supposed to. The same with our OCD affected brains. If you could somehow replace whatever it is in our head thats malfunctioning some fo the time with a brand new, non-flawed version, the situations that trigger us now would no longer be a problem. Stress wouldn't exacerbate our symptoms. So yes environmental factors and our own learned behavior do have an affect on our OCD, but they aren't the root problem. We can help reduce the occurrence and severity of that root problem by changing our behavior and being aware of our environment, just like you can help your old car start better by say, keeping it inside your garage where it doesn't get so cold (CBT), or using a higher quality lubricant (SSRI's) that help even a broken part function more smoothly.

And thats great! I am forever grateful for the fact that our brains are flexible enough to respond to behavioral therapy to work around our messed up brains. I'm forever grateful to live in a time where we have drugs that are effective at helping treat and manage OCD. We can't (yet) change that underlying flaw in our brains, and that sucks, but we CAN work around it. A biological basis for OCD doesn't change that we can do things to help ourselves live better lives, anymore than a biological basis for alcoholism doesn't change that a person CAN work around that problem by changing their behavior and approach to life. Thats great. We aren't simply robots, doomed to follow our programming and powerless to do anything about the path we are on. By all means we should continue to encourage sufferers to do what works to live better lives (CBT and medication). Whatever the root cause of OCD, the reality is it doesn't matter in terms of how we manage it on a day to day basis too much. But recognizing a probably biological basis for OCD allows us to continue research in that area. It allows us to recognize that people afflicted with OCD aren't at fault for it happening in the first place (though we are responsible for choosing/acting to do the work necessary for recovery). A biological source for OCD isn't an excuse to do nothing, anymore than someone who loses an arm or a leg in an accident thats not their fault is no longer responsible for what happens in their life. They can choose their path forward, even if its limited in some ways by the reality of their situation. I have to work around OCD as i navigate my life, just like i've had to navigate around having a peanut allergy and asthma. I can't change that these things are part of me, but I CAN change how I live my life in response to that truth.

Your relapse may have had a very specific trigger, and yes, you may have been able to manage the severity based on the response you made, but the reason it happened in the first place? The reason the intrusive thought even caused you to HAVE a reaction like you did? I firmly believe the underlying problem stems from that slightly broken gear in your brain. Consider the following analogy, you are driving along the road and your car hits an icy patch. Now you didn't choose to hit that icy patch, you couldn't see it, it was simply there, a factor outside your control. But what happens next IS going to depend on your reactions and how you handle things. You could panic, lose control and create a bigger mess, but maybe you have practiced safe driving skills and you can apply those to the situation and keep the effects of your car skidding out to a minimum, maybe even no damage, just a little bit of a scare. So yes, absolutely we can learn behaviors to manage our responses to situations triggered by forces beyond our direct control, we do that all the time. But just because we can (and do) use behavior to manage our responses doesn't mean that the initial source of the problem was also something we did in the first place.

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I have sat there, confident in my knowledge of the realities of the situation, knowing all the details, knowing the data, the science, the facts, and STILL felt anxiety for no discernible reason. I KNEW in my head that my fear was ridiculous, yet I also couldn't stop feeling anxious about it.

I think you could apply the same to someone that sufferers from panic disorder or phobias (my original point). They are feeling anxious for no known reason, they have had it explained dozens of times that there is no reason for fear, they've had the anxiety spiral explained, they know about breathing, logically they know what to do.....and yet they can't do it. You are very lucky if you can apply simple reasoning or just say to yourself "Oh, don't worry".......many are bound by this anxiety and fear for decades regardless of applying logic.

16 hours ago, dksea said:

a person whose brain is damaged by stroke can learn to talk again using other parts of their brain. ﻿

Sometimes but not always. It very much depends on the area of, and extent of the damage. Sometimes the effects of the stroke are irreversible.

12 hours ago, dksea said:

It allows us to recognize that people afflicted with OCD aren't at fault for it happening in the first place

I don't think blame comes into it, of course it's not our fault that we suffer from OCD whatever the cause. It's not someone's fault that they suffer from an anxiety condition, they aren't to blame, they aren't weak.